More than one million total joint replacement surgeries are performed in the United States every year. Persistent pain from arthritis is the most common complaint among people who choose to undergo these procedures, with the majority of orthopedic replacements completed on the knees, hips and shoulders.
Arthritis will eventually affect most people over 60 years old, with varying degrees of severity, but younger people can also develop arthritis due to an injury or repetitive stress caused by overuse.
Genetic factors play a significant role in the likelihood of developing arthritis, but there are still crucial lifestyle choices that everyone can make to promote healthy joints and prevent the need for joint replacement surgery.
“Lifestyle changes can be really important when it comes to modifying or trying to stop the acceleration of the wearing away of cartilage,” said Christopher Selgrath, DO, an orthopedic surgeon at Nazareth Hospital.
Prevention
The three pillars of prevention for joint degeneration are physical exercise, weight management and a healthy diet that reduces inflammation.
The biggest deterrent to worsening joint problems is maintaining a balanced fitness plan that includes a regular mix of strength, balance and flexibility exercises.
Not all physical activity needs to be structured. Even parking at a distance from a store to get in some extra steps can be good for your joints or using exercise as a time to catch up with friends and spend time with family.
Since our joints bear the brunt of the day-to-day movements we make, they take on more stress and wear in people who are overweight.
"For every extra pound of weight a patient is carrying, it's really five pounds of extra force, mechanically, that's going through the joints — particularly going up and down steps," Dr. Selgrath said. "That can really be detrimental to a bad joint."
As patients start to feel pain from an arthritic joint, they often become reluctant to use it. A sedentary lifestyle is one of the worst risk factors for joints to lose strength, especially when accompanied by a poor diet.
Dr. Selgrath advises patients to avoid processed foods, high intake of sugars and too many simple carbohydrates, such as breads and pastas, that provide empty calories.
When is it time to consider joint replacement?
People who feel chronic joint pain should not let it linger.
"The sooner you get in to see a doctor, the quicker we can try to reverse whatever damage is occurring," Dr. Selgrath advised. "I wouldn't let the pain go too long."
Typically, an orthopedic surgeon will use oral and topical medications to alleviate a patient's pain enough for them to participate in a physical therapy program. The next step might be injections that can help a patient tolerate enough regular activity to strengthen the joint.
Dr. Selgrath specializes in treating a range of orthopedic problems including painful joints, especially in the knees. He views joint replacements as a last resort to be taken when a patient's X-rays show clear cartilage loss or bone-on-bone contact in addition to debilitating pain.
At Nazareth Hospital in Northeast Philadelphia, Dr. Selgrath routinely performs partial and total knee replacements in patients who need surgical intervention.
Last December, Trinity Health Mid-Atlantic began using a Robotic Operative Surgical Assistant (ROSA) to improve the outcomes of patients who undergo knee replacement. The precision of robotic surgery — within a millimeter or a degree — enables most patients to have a quicker recovery and reduce the likelihood that a revision or second surgery will be necessary. Most patients are able to be discharged from the hospital within 24 hours.
"The robot has been shown to help us better align the knee replacement and make us more accurate, which gives the patient a more balanced knee," Dr. Selgrath said. "Our hospital has invested in technology that is purely helping patient care and putting the patient at the forefront of the encounter."
Recovery
"Recovery is based on your body's ability to get back to whatever you're trying to achieve. Some people want to get back to walking around the house and cooking. Others are recovering to do yard work and walk a few miles a day, or participating in athletics," Dr. Selgrath said. "What the surgery is going to do is alleviate the pain that has inhibited activity and reduced range of motion. It gives the patient the chance to regain the strength and endurance they need."
For some patients, a reduction in pain can happen as quickly as four to six weeks. For others, it may take four to six months. The same lessons about prevention apply to protecting the replaced joint and the rest of the body once patients are functioning more normally again.
Learn more about Christopher Selgrath, DO and the orthopedics program at Nazareth Hospital by visiting the Trinity Health Mid-Atlantic website.